Identification of Leptospira Species in Environmental Soil of Urban Settlements in Cambodia.

Background: Leptospirosis represents a major public health threat in Cambodia. To help establish preventive strategies for leptospirosis, we isolated and identified Leptospira from soil collected in Phnom Penh and its neighboring province during the dry and rainy seasons. Materials and Methods: Soil samples were collected from 15 sites in the Phnom Penh metropolitan area and Kandal Province in 2019 and 2020. A total of 120 soil samples were collected and analyzed after culturing. Cultured isolates were identified at the species level using 16S rRNA and gyrB gene sequencing analysis. Results: The positive culture rate for Leptospira was significantly higher for samples collected during the rainy season (31 out of 60 samples, 51.7%) than during the dry season (19 out of 60 samples; p < 0.05, chi-squared test). In terms of sampling area, 10 (35.7%) and 13 (46.9%) soil samples from Phnom Penh and 9 (28.1%) and 18 (56.3%) soil samples from Kandal Province were culture-positive when collected during the dry and rainy seasons, respectively. Three isolates from the Kandal samples collected during the dry season were categorized as pathogenic clade type P1 according to 16S rRNA and gyrB sequence analyses. In addition, samples collected during the rainy season from Phnom Penh and Kandal Province (three each) were categorized as clade type P1. The samples with isolates in clade type P1 were collected from riverbanks during both the dry and rainy seasons and from a hospital garden during the rainy season. Conclusions: This is the first report on the isolation of clade P1 Leptospira species in environmental soil samples from Cambodia. Environmental soil appears to be a reservoir for Leptospira in the capital city and surrounding areas of Cambodia. This study contributes to the understanding of Leptospira species distribution in Asian countries.

Role of a rapid response system and code status discussion as determinants of prognosis for critical inpatients: An observational study in a Japanese urban hospital.

ABSTRACT: Rapid response systems (RRS) have been introduced worldwide to reduce unpredicted in-hospital cardiac arrest (IHCA) and in-hospital mortality. The role of advance care planning (ACP) in the management of critical patients has not yet been fully determined in Japan.We retrospectively assessed the characteristics of all inpatients with unpredicted IHCA in our hospital between 2016 and 2018. Yearly changes in the number of RRS activations and the incidence of unpredicted IHCA with or without code status discussion were evaluated from 2014 to 2018. Hospital standardized mortality ratios were assessed from the data reported in the annual reports by the National Hospital Organization.A total of 81 patients (age: 70.9 ±â€Š13.3 years) suffered an unpredicted IHCA and had multiple background diseases, including heart disease (75.3%), chronic kidney disease (25.9%), and postoperative status (cardiovascular surgery, 18.5%). Most of the patients manifested non-shockable rhythms (69.1%); survival to hospital discharge rate was markedly lower than that with shockable rhythms (26.8% vs 72.0%, P < .001). The hospital standardized mortality ratios was maintained nearly constant at approximately 50.0% for 3 consecutive years. The number of cases of RRS activation markedly increased from 75 in 2014 to 274 patients in 2018; conversely, the number of unpredicted IHCA cases was reduced from 40 in 2014 to 18 in 2018 (P < .001). Considering the data obtained in 2014 and 2015 as references, the RRS led to a reduction in the relative risk of unpredicted IHCA from 2016 to 2018 (ie, 0.618, 95% confidence interval 0.453-0.843). The reduction in unpredicted IHCA was attributed partly to the increased number of patients who had discussed the code status, and a significant correlation was observed between these parameters (R2 = 0.992, P < .001). The reduction in the number of patients with end-stage disease, including congestive heart failure and chronic renal failure, paralleled the incidence of unpredicted IHCA.Both RRS and ACP reduced the incidence of unpredicted IHCA; RRS prevents progression to unpredicted IHCA, whereas ACP decreases the number of patients with no code status discussion and thus potentially reducing the patient subgroup progressing to an unpredicted IHCA.

Molecular Epidemiological Survey of Leptospira Infection of Wild Rodents in the Urban Settlement of Cambodia.

INTRODUCTION: Leptospirosis remains a major public health threat in Cambodia. In this study, we aimed at facilitating the development of preventive strategies against leptospirosis in Cambodia by conducting molecular epidemiological surveys of Leptospira infection among wild rodents. MATERIALS AND METHODS: One hundred sixty-three wild rodents were captured in the capital Phnom Penh and surrounding areas, and their kidneys and bladders were collected for analysis. Identification of wild rodent species was determined by using the cytochrome c oxidase I gene. TaqMan PCR of the flagellin B gene (flaB) was performed to detect Leptospira, and species of the isolates were identified by flaB sequencing analysis. RESULTS: The species and respective number of rodents collected were as follows: Rattus norvegicus, 80 (49.1%); Rattus argentiventer, 53 (32.5%); Rattus exulans, 6 (3.7%); Rattus indica, 15 (9.2%); Maxomys surifer, 3 (1.8%); and Rattus sp., 6 (3.7%). Leptospira was detected in 20 out of the 163 rodents (12.3%) and was categorized as either Leptospira interrogans or Leptospira noguchii. R. norvegicus had the highest prevalence of Leptospira (17.5%), and R. argentiventer and Rattus sp. showed infection rates of 9.4% and 16.7%, respectively. CONCLUSIONS: Based on these results, wild rodents living in urban areas of Cambodia were found to be important reservoirs of highly virulent Leptospira. The flaB sequence results of our study provided information regarding the prevalence of Leptospira species, which was dependent on the rodent species. This study is the first study on leptospirosis in wild rodents in the urban areas of Cambodia, where there is limited information on leptospirosis.

[Strategy Development for International Cooperation in the Clinical Laboratory Field].

The strategy of international cooperation in the clinical laboratory field was analyzed to improve the quality of intervention by reviewing documents from international organizations and the Japanese government. Based on the world development agenda, the target of action for health has shifted from communicable diseases to non-communicable diseases (NCD). This emphasizes the importance of comprehensive clinical laboratories instead of disease-specific examinations in developing countries. To achieve this goal, the World Health Organization (WHO) has disseminated to the African and Asian regions the Laboratory Quality Management System (LQMS), which is based on the same principles of the International Organization of Standardization (ISO) 15189. To execute this strategy, international experts must have competence in project management, analyze information regarding the target country, and develop a strategy for management of the LQMS with an understanding of the technical aspects of laboratory work. However, there is no appropriate pre- and post-educational system of international health for Japanese international workers. Universities and academic organizations should cooperate with the government to establish a system of education for international workers. Objectives of this education system must include: (1) training for the organization and understanding of global health issues, (2) education of the principles regarding comprehensive management of clinical laboratories, and (3) understanding the LQMS which was employed based on WHO's initiative. Achievement of these objectives will help improve the quality of international cooperation in the clinical laboratory field.

Effectiveness of a condom use educational program developed on the basis of the Information-Motivation-Behavioral Skills model.

AIM: To assess a condom use educational program developed using the Information-Motivation-Behavioral Skills (IMB) model to enable Japanese young people to use condoms. METHODS: The program was implemented in two sessions of approximately 90 min each over a 2 day period. The participants underwent the program in small same-sex groups. The study participants were divided into the intervention group (n=94) and the control group (n=186). Knowledge relating to HIV/sexually-transmitted diseases (STDs), attitudes towards contraception and sex, the risk perceptions of pregnancy and HIV/STD infection, anticipated reaction to proposed condom use, self-efficacy of condom use, and sexual behaviors were assessed. Data were obtained at baseline, immediately after the program, and 1 and 3 months after the program or baseline survey. RESULTS: Intervention group participants with experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs, self-efficacy of condom use, and relief/confusion associated with condom use than the control group (n=13) at the 1 and 3 month surveys. Intervention group participants with no experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs and self-efficacy of condom use, and significantly lower scores for condom avoidance, than the control group (n=116). Condom use behavior was not changed in either group. CONCLUSION: The program used in this study did not promote condom use, but it increased knowledge relating to HIV/STDs and self-efficacy of condom use and reduced resistance to condom use.

Self-assessed health and menopausal symptoms among 50-year-old Japanese women: cross-sectional surveys in Northern Kawasaki in 1998 and 2008.

OBJECTIVE: The aim of this study was to determine whether self-assessed health changed over the last decade in association with menopausal symptoms among community-dwelling Japanese women. METHODS: Cross-sectional surveys of 50-year-old women living in Northern Kawasaki were conducted in 1998 (n = 1,492) and 2008 (n = 1,274). Data obtained from a questionnaire were self-assessed health, menopause awareness, 1-year recall of 10 subjective symptoms (Simplified Menopausal Index), and sociodemographic, lifestyle, and health characteristics. The prevalence of poor self-assessed health, menopause awareness, and subjective symptoms was compared between the surveys. RESULTS: The percentage of premenopausal women increased from 51.7% in the 1998 survey to 64.8% in the 2008 survey (P < 0.001). The prevalence of menopause awareness decreased from 36.8% in the 1998 survey to 31.7% in the 2008 survey (P = 0.006). The prevalence of poor self-assessed health decreased from 13.9% in the 1998 survey to 10.8% in the 2008 survey (P = 0.013). Multiple logistic regression analysis showed that participants of the 2008 survey had a significantly lower risk for having poor self-assessed health than did participants of the 1998 survey. Menopause awareness, comorbidity, and body mass index of 18.5 kg/m2 or lower or 25.0 kg/m2 or greater were significantly associated with increased risk for having poor self-assessed health. The impact of menopause awareness on self-assessed health was 2.2 to 2.4 times greater in participants without comorbidity than in those with comorbidity. CONCLUSIONS: There was a significant improvement in self-assessed health in parallel with a significant downward secular trend in the prevalence of menopause awareness among community-dwelling Japanese women. Women who felt themselves affected by menopause tended to perceive their own health as poor.

Cross-sectional community survey of menopause symptoms among Japanese women.

OBJECTIVES: To determine the prevalence and characteristics of climacteric symptoms and related factors among 50-year-old Japanese women. METHODS: A self-administered questionnaire was mailed to all 50-year-old women (n=3166) in three northern wards of Kawasaki City regarding 10 menopausal symptoms (hot flashes, sweats, insomnia, depression, palpitation, chills, irritation, headache, fatigue, and stiff shoulders) as well as demographic, lifestyle, psychological, socio-economic and physical factors. The questionnaire included closed-ended questions about symptoms over a 1-year recall time frame. The response rate was 55%, and women with current illness, a history of gynecological or endocrinological disorders and those on HRT were eliminated. We finally analyzed data from 1169 (37%) women. RESULTS: The prevalence of hot flashes was 36.9%. These, together with sweats, insomnia and depression, were associated with menstrual status. All four symptoms were also associated with lifestyle and socio-psychological factors. Psychological stress (unease or anxiety) was associated with all 10 symptoms investigated. The two most prevalent symptoms, namely, fatigue (64.7%) and stiff shoulders (75.4%) were associated with psychological and lifestyle factors. CONCLUSIONS: Hot flashes were experienced by more women in the present community-based study than in most previous studies of Japanese women. We found that hot flashes ('hoteri' in Japanese) are related to menstrual status. Symptoms both related and unrelated to menstrual status were associated with lifestyle, psychological factors and BMI.

The present status of the clinical laboratory medicine in Cambodia.

The educational system and the introduction of legislation of clinical medicine are both still in developing stage in Cambodia where only 10 years have passed since the establishment of a new government. In order to maintain good health of all Cambodian citizens and to improve the quality of care in health services, it should be necessary to implement an appropriate educational system for both laboratory technologists and technicians. To conduct refreshment training course for laboratory workers with provision of the instruments, material and reagents is another way to make improvement of it in public hospitals. It should be also required to overcome economic problems how to absorb medical expense and to understand the importance for doctors to diagnose with scientific data of clinical examinations. Maturation of the total medical system in this country should be necessary and suggestions from neighboring countries with views toward the world standard would be expected.